Evaluation of First Visit

I received a copy of some of my medical records the other day. This blog entry is to discuss what the Physician’s Assistant stated and what I recall from the first visit.

The date of the first visit was September 9th 2005. I of course had gone in due to increased frequency of stools, accompanied by blood. In the record it uses the acronym ‘brbpr’, apparently that is easier to write than ‘bright red blood per rectum’. I had no real diarrhea at the time, just the increased stools, not watery or anything like that. Unfortunately I hadn’t been lucky enough to have done any foreign travel recently, although later they would sometimes insinuate that this was something I picked up in Mexico 10 years earlier.

Along with the bloody stools, I was experiencing an increased need to urinate. I would not urinate as much as I normally did, but would feel the need to urinate just a few minutes later. No burning or real pain accompanied this, it was just that uncomfortable ‘time to go pee’ feeling.

I did have a history of several years of diarrhea when I ate large amounts of certain junk foods, such as on long car rides. I also had a several year history (not mentioned in the doctor’s notes) of diarrhea when I drank something really sweet such as apple juice or especially white grape juice.

I had some abdominal pain upon palpation of the lower abdominal quadrants, blood in stool, poor appetite and rectal bleeding (doesn’t blood in the stool include that). I did NOT have heartburn, gas, constipation (had never had that in my whole life), diarrhea, nausea, vomiting, stomach cramps, polyphagia (excessive hunger or eating), abdominal swelling or jaundice (yellow skin). I should mention here that a digital rectal exam was not performed at this time. (You know, when they put the gloved finger where you don’t want them to.)

The record states that I denied cold intolerance. I don’t recall being asked that. Not having grown up in a climate as cold as Idaho, I have been one to get purple nail beds easily and don’t tolerate or appreciate the cold very well.

I had no aphthous ulcers (canker sores). Nor did I have a Virchow’s node. A Virchow’s node is an enlarged lymph node above the left clavicle on the neck. This can be a sign of cancer or serious infection. I also did not have an umbilical node. This would be an enlarged lymph node on the abdomen (umbilicus means belly button).

The conclusion made by the Physician’s Assistant was that this could be as simple as IBD (Irritable Bowel Syndrome) with hemorrhoids. He also states that this could be cancer (one of the ‘C’ words I learned to hate). A colonoscopy was ordered as were stool WBC (white blood cells), stool O&P (ova (egg) and parasite), stool C&S (culture and sensitivity), stool Giardia antigen, C difficile toxin (a toxin produced by clostridium difficile). You’ve probably heard of Giardia (giardia lamblia). Clostridium difficile is hard to grow in the lab so they test for a toxin it produces.

In short I had to go to a lab and get blood drawn and poop into a sterile container. Then I had to await the results and was scheduled for a colonoscopy - the test people don’t exactly line up for. I knew they weren’t as bad as people think. As a medic in the Air Force I had seen colonoscopies performed. The worst part is the prep you have to drink. Next to that the IV is the hardest part. After that you go to sleep and don’t remember anything (unless maybe your doctor doesn’t like you enough to give you enough medication). But seriously people shouldn’t be afraid of getting a colonoscopy. Early detection of colon cancer by colonoscopy saves thousands of lives every year. Unfortunately it could save many more (think about what that means).

First Doctor's Visit

The day finally came for my first visit to the Gastroenterologist. I checked in at the desk and waited. We all know what it's like to wait in the doctor's office - a fish tank, some magazines, some more waiting, wondering why you're paying to wait 20 extra minutes. I looked around this large waiting room and noticed that at age 30, I was by far the youngest patient in the room.

A glance at the magazines available told the same story. I seem to remember titles like - Senior Living, Retired and Old, I Have More Wrinkles Than You! and Oh the Places I've Already Been. Ok, so most of those were made up, but you get the idea - this place was for people older than I was... or so I thought.

After the nerve-racking wait, I was summoned to get my vital signs checked. Along the way it seems I got asked a similar series of questions by the nurse's aid, the nurse, and eventually the Physician's Assistant. They would take note of my weight - not overweight at all. I informed them that I was running until this started 3-6 times per week. At first they were straight-forward with their questions, then more disbelieving -

Any abdominal pain? no
Ever been told you have hemorrhoids? no
Do you drink? no
Do you smoke? no
Have you ever drank? no
Have you ever smoked? no
Any family history of intestinal problems or cancer? no

The questions went on and on, and they seemed ever the more skeptical. I felt like they were either terrified of what I might have, or thought I was making the whole thing up.

Eventually the P.A. said something like, "Well, you're too young to have cancer so it's either diverticulitis or Crohn's Disease." This led me to believe that the first thing he thought of was cancer. He said it could also be a parasite. Blood work, a stool sample, and a colonoscopy were ordered. The couple weeks it would be until the colonoscopy seemed an eternity away!

First Symptoms

The first symptoms occurred in about August of 2005. There was some blood in the toilet. Not a lot, but some each time I had a bowel movement. No pain meant it probably wasn't hemorrhoids. I decided not to go to the Doctor right away. I've never been the type to run to the Doctor the instant I felt a sniffle or something. As I tried to convice myself each day that this wasn't a big deal, I started to realize it might be.

Especially concerning to me was the fact that I had no pain with the bloody stool. If there had been sharp pain I would have assumed the blood was from hemorrhoids, even though I had never had any. Without the pain, other possibilites creeped in. Could it be a polyp? Was it cancer? The blood seemed to be increasing a little. Now I was having stools three times per day instead of one.

Not wanting to concern my wife, I decided to make a Doctor's appointment on my own. I consulted a friend, Nancy, for the names of some local gastroenterologists. She was somebody I trusted. She is somebody I would come to lean on for advice and support on a regular basis.

I called a Doctor's office and made an appointment. They wanted to know if there was pain? - No. How about cramping? - No. Any abdominal discomfot at all? - Well, if I push on my bladder hard enough then it kind of hurts. They said they would send me some papers to fill out and bring to my appointment, which was in a week or so.

A day or two later my wife came to me and asked what a gastroenterologist was. Why? She explained that we must have gotton some mail intended for my father or grandfather (we have similar names). I told her it was mine. She became very concerned as I had to explain what had been going on. She wanted to know why I hadn't told her sooner. You worry too much! That was three or four weeks you didn't have to worry.

Now I just had to wait for that first appointment.

The Healthy Times

Health used to be something I took for granted. Six months or a year before I got sick, one of my cousins asked if I might be interested in using USANA vitamins. I told her no thanks, after all I was healthy. During the months that weren't so cold, and the roads weren't icey, I would go jogging 3-6 miles per day 4-6 times per week. I enjoyed working in the yard, and being active outdoors. It wasn't like I was a weakling or something! Like the typical young male, I thought I was invincible. Like I said though, I was taking this for granted, instead of taking the best possible care of my body. Who knows what could have made a difference, but I was about to find out that good health was a blessing, and not to be taken for granted. Just because I didn't smoke or drink and I wasn't overweight didn't mean I couldn't get sick.

Medical Technician

Ironically, I had some experience in the medical field. I had joined the Air Force in 1997 and served 4 years as a Medical Technician. I was trained in many areas in the hospital and had served significant amounts of time in several areas including: Labor and Delivery, Medical Surgical unit, PACU (pari-anesthesia unit), and ASU (ambulatory or same-day surgery unit). I had been out of the Air Force since 2001 and had actually missed the job satisfaction I enjoyed as a Medical Technician. After I separated from the military I had worked in a call center, purchased some apartments and worked in finance. The people I worked with were great, but I still missed working in the medical field. I had found it very satisfying to help people in that capacity.

Beginning

So, I've decided to take the jump and write my own blog. Mostly I plan on writting about my J-pouch and my struggles leading up to it, as well as my daily life with it. If you don't know what a J-pouch is, don't worry... you'll soon find out. I do have a sense of humor, so this won't be quite like reading a textbook or a boring newspaper article. So if you read something in my blog and you can't decide if I was serious, I probably wasnt' (at least partially).